Basic Information
| Provider Information | |||||||||
| NPI: | 1770691024 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ST. MARY'S HOSPITAL OF ST. MARY'S COUNTY, INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 527 | ||||||||
| Address2: | HEALTH CONNECTIONS | ||||||||
| City: | LEONARDTOWN | ||||||||
| State: | MD | ||||||||
| PostalCode: | 206500527 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3014756185 | ||||||||
| FaxNumber: | 3014756143 | ||||||||
| Practice Location | |||||||||
| Address1: | 25500 POINT LOOKOUT RD | ||||||||
| Address2: | HEALTH CONNECTIONS | ||||||||
| City: | LEONARDTOWN | ||||||||
| State: | MD | ||||||||
| PostalCode: | 206500527 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3014756185 | ||||||||
| FaxNumber: | 3014756143 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/28/2006 | ||||||||
| LastUpdateDate: | 06/10/2008 | ||||||||
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| AuthorizedOfficialLastName: | SUTAY | ||||||||
| AuthorizedOfficialFirstName: | REBECCA | ||||||||
| AuthorizedOfficialMiddleName: | JEAN | ||||||||
| AuthorizedOfficialTitleorPosition: | DIABETES EDUCATOR/DIETITIAN | ||||||||
| AuthorizedOfficialTelephone: | 3014756185 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MS. | ||||||||
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| AuthorizedOfficialCredential: | MS, RD, LDN, CDE | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 282NR1301X | DO0679 | MD | Y | Hospitals | General Acute Care Hospital | Rural |
ID Information
| ID | Type | State | Issuer | Description | 211539 | 05 | MD | MEDICAID |